Sunday, May 9, 2010

Sunday’s Specialty – 1st Edition – Neurology Nursing

I am so excited about this first edition. When I contacted Jo over at Head Nurse to see if she would be interested in contributing I was meet with an enthusiastic “hell yeah”. I was honored that she was so willing to share her expertise with us. She is an amazing blogger. She tells her stories with honesty and hilarity all in one. She loves her job and it shows. I absolutely love reading about her experiences and am so thrilled that she agreed to share the love with us.

So without further ado, here is our first edition of Sunday’s Specialty. A look into the world of Neurology Nursing brought to us by Head Nurse. After you read about it, head on over (no pun intended) to Head Nurse to read more about life in Neurology.

Neuroscience, or: Brains: They're not just for zombies any more

I am a neuroscience nurse. Brains and spines and peripheral nerves are what I do. I got into the field totally by accident and stay in it for two reasons: first, I love what I do; second, when you say, "I work in neuroscience" to a skeevy guy at a bar, he immediately fails to make any nurse-related jokes he had in store and instead looks at you with new respect.

Neuroscience is interesting. It's never the same two days in a row. It requires smarts, creativity, endless patience, and a certain level of steely determination. It also keeps you young, makes your skin clear and luminous, and improves the color and texture of your fur.

Okay, not really. But you do get to work with some amazingly smart people.


Neuroscience is anything that has to do with the brain, the spinal cord, or the peripheral nervous system. Anything from brain tumors to spine injuries to strokes to MS, ALS, or CJD can fall under this category. Basically, if you have a problem in your central or peripheral nervous system, you're a neuroscience patient.

The fascinating thing about neuroscience is this: once a surgeon gets his fingers into your brain (as it were), everything else in your body is affected. I tell my patients who are recovering from brain surgery that their recovery process is very much like trying to walk on a sprained ankle: the portion of their body that's getting the most use is also trying to heal at the same time.

This means, realistically, that I have to be aware of everything from heart rhythms to electrolyte balances to muscle strength on an hour-by-hour basis. Brains and spines and nerves affect *everything*, so you have to be flexible and have strong nursing skills all around.


Basically, caring for the neurological or neurosurgical patient is the same as caring for any other patient, with a few little tweaks.

If it's a patient with a spine injury, a lot of what I do is focused on preserving or restoring any function the patient can have below the level of the injury. Skin care and physical therapy are huge in these cases, and the patients can be very labor-intensive--things tend to go wrong suddenly with high spine injuries.

If it's a patient whose post-op from having a brain tumor removed, there's a fine line I have to walk between pain control and sedation. There are also issues with salt-wasting and diabetes insipidus and seizure control, depending on where the tumor was. And, of course, there are hourly neuro status checks, to make sure that nothing's busted loose or changed inside the brain.

If it's an occlusive stroke I'm dealing with, there's the whole science behind balancing declotting the area with TPA versus not allowing a reperfusion injury to occur. If it's somebody who's got one-sided neglect, care can range from teaching them that one side of the universe still exists to moving everything in the room around to reinforce that concept.

If it's something that affects the peripheral nervous system, or something like MS or CJD, well, whole books have been written on nursing care in those situations. Let's just acknowledge that the nursing care for patients with peripheral nerve injuries or demylenating diseases is complex and creative.


Drains coming out of people's backs. Drains coming out of their brains. Real live cases of mad cow disease, without the cow exposure. Strange things nobody can identify. Worms in brains. Foreign objects in brains. People drilling into other people's brains at the bedside.


Let's cover the downsides first: both the patients and the doctors tend to be strange in the extreme. If you don't have a lot of patience for deciphering what your patient who can't talk is trying to say, and if you don't have a lot of patience for doctors who apparently weren't raised on this planet, you won't last long in neuroscience. The work is hard--sometimes physically as well as mentally challenging--and sometimes heartbreaking...but that's the same all over nursing.

The upsides to doing neuroscience are these: you never get bored. Neuroscience is something that garners more respect than other fields, because it's seen as the province of extremely smart people. It's sexy as hell. And, if you're a big ol' geek like me, you'll find yourself fitting in perfectly with the group of smart, geeky, curious people you work with.


As I said, I fell into this specialty entirely by accident. If you want to do neuroscience on purpose, though, I would recommend that you find a good teaching hospital with a good neurosurgery and/or neurology reputation to work at. I emphasize teaching hospital because you'll have a whole lot to learn, and teaching hospitals attract people who, to teach.

Med-surg experience is not necessary before you go into this specialty. The care is weirdly different in a lot of ways from straight med-surg, so the two don't overlap much.

As far as education goes, a good grasp of where the brain is (on the top) and where the spine is (down the back) is really all you need. Protocols differ widely from facility to facility, so you're likely to learn everything you need to know, and then some, once you start work.

I love my job. It makes sense to me, what the brain does and how it affects the body. I love my coworkers: they're smart, funny, and insane. I love my patients, who show me all the weird quirks the human machine can develop after an injury to its computer system. I say to all of you who might be interested in neuroscience as a career, c'mon in! The CSF is fine.

Thank you so much Jo, for giving us an incredible look into the world of Neurology Nursing!!


  1. Loved it! These post are going to be fun! I can't wait to read next weeks already!

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  3. Yeah!! That was awesome for the first post.. The rest of us better get our acts together!!

  4. SO happy you went ahead with doing this! My Sunday's just got a little bit better. And what an awesome first post-- not so well known of an area and a brilliant writer!

  5. You guys rock. Thank you for all the sweet words! Y'know, this is the first time I've ever done a guest post, and I'm just tickled at how well it came out. Thanks again, a billion times, for the opportunty. Wahoo!

  6. Awesome Jo as usual. My son Brennan died from a variant of Alper's Disease which is quite similar to CJD/MCD but genetic and more traumatic as it hits infants.(Traumatic to moms anyways) I wish we'd had a nurse or two like you. The 7 weeks we were in and out of Children's were the most frustrating powerless scary and aggravating weeks of my 48 years. He died in 2/96 and by June 1996 I knew more than any neurologist in Western WA knew about the disease. with the advent of the internet anyone can find out about orphan diseases and rare disorders, in 1996 you really had to search hard.

    It would have been nice to have someone with some common sense and a practical viewpoint.

    Anyhoo great post.

    You are always welcome to guest post at my blog perhaps about how to find a job as an LPN new grad where no one will hire a person with no nursing experience?

  7. Excellent post guys.

    This is an area that already had me intrigued.
    And now even more so.

    well done.